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Gao L, Yu K, Feng Y, Yan F, Qian C. Intraventricular haemorrhage treated by extra ventricular drainage with catheter mistakenly penetrating the cisterna ambiens: A case report. J Int Med Res 2024; 52:3000605241237680. [PMID: 38606755 PMCID: PMC11015790 DOI: 10.1177/03000605241237680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/20/2024] [Indexed: 04/13/2024] Open
Abstract
Intraventricular haemorrhage (IVH) is a severe and acute type of stroke with a complex pathophysiology and is a therapeutic challenge. This case report described a man in his early 50's diagnosed with IVH by computed tomography (CT). Although bilateral extraventricular drainage (EVD) was undertaken, a postoperative CT scan showed that while the left catheter was correctly positioned, the right catheter had been wrongly inserted into the cisterna ambiens. The procedure was equivalent to simultaneous EVD combined with cisternostomy. As a consequence, the haematoma was rapidly removed, the risk of infection and long-term hydrocephalus was reduced, and prognosis was improved. Large case-control studies or prospective studies are needed to evaluate the safety and effectiveness of this treatment modality.
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Affiliation(s)
- Liansheng Gao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Kaibo Yu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Yanfei Feng
- Department of Urology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Yan
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
| | - Cong Qian
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
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Noiphithak R, Phumichard T, Ratanavinitkul W, Rukskul P. Prediction of Permanent Shunt Dependency in Patients with Intraventricular Hemorrhage: Outcomes of Early External Ventricular Drainage Weaning Protocol. World Neurosurg 2023; 179:e575-e581. [PMID: 37689359 DOI: 10.1016/j.wneu.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Hydrocephalus remains a common sequela of intraventricular hemorrhage (IVH) despite adequate drainage of the hematoma, including endoscopic surgery, intraventricular fibrinolysis, and external ventricular drainage (EVD). Moreover, the appropriate timing for conversion from EVD to ventriculoperitoneal shunt (VPS) is uncertain. This study aimed to evaluate the predictors of shunt dependency in patients with IVH based on the early EVD weaning protocol in our institution. METHODS We retrospectively reviewed medical records of patients who were diagnosed with primary IVH and secondary IVH from spontaneous intracerebral hemorrhage during the period 2018-2021. Predictors associated with shunt dependency were identified using a logistic regression model. The cutoff point of each variable was selected by receiver operating characteristic curve analysis. Furthermore, shunt complications were reported as a safety measure of our early EVD weaning protocol. RESULTS The analysis included 106 patients. After IVH treatment, 15 (14%) patients required ventriculoperitoneal shunt, whereas 91 (86%) patients were shunt-free. The diameter of posttreatment temporal horn and the degree of IVH reduction were the significant predictors of shunt dependency. Moreover, patients with IVH reduction of >45% and temporal horn diameter of <9 mm had a lower probability of shunt dependency. Shunt failure was found in 2 (13.3%) patients. CONCLUSIONS This study showed that a large temporal horn diameter and a lower degree of IVH removal were predictors of shunt dependency in patients with IVH. In addition, early conversion from EVD to ventriculoperitoneal shunt is safe and feasible.
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Affiliation(s)
- Raywat Noiphithak
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand.
| | - Thapakorn Phumichard
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand
| | - Warot Ratanavinitkul
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand
| | - Pataravit Rukskul
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand
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Haldrup M, Miscov R, Mohamad N, Rasmussen M, Dyrskog S, Simonsen CZ, Grønhøj M, Poulsen FR, Bjarkam CR, Debrabant B, Korshøj AR. Treatment of Intraventricular Hemorrhage with External Ventricular Drainage and Fibrinolysis: A Comprehensive Systematic Review and Meta-Analysis of Complications and Outcome. World Neurosurg 2023; 174:183-196.e6. [PMID: 36642373 DOI: 10.1016/j.wneu.2023.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND External ventricular drainage (EVD) is a key factor in the treatment of intraventricular hemorrhage (IVH) but associated with risks and complications. Intraventricular fibrinolysis (IVF) has been proposed to improve clinical outcome and reduce complications of EVD treatment. The following review and metaanalysis provides a comprehensive evaluation of IVH treatment with external ventricular drainage (EVD) and intraventricular fibrinolysis (IVF) with regards to complications and clinical outcomes. METHODS The PRISMA guidelines were followed preparing this review. Studies included in the meta-analysis were compared using forest plots and the related odds ratios. RESULTS After a literature search, 980 articles were identified and 65 and underwent full-text review. Forty-two articles were included in the review and meta-analysis. We found that bolted and antibiotic-coated catheters were superior to tunnelled/uncoated catheters (P < 0.001) and antibiotic- vs. silver-impregnated catheters (P < 0.001]) in preventing infection. Shunt dependency was related to the volume of blood in the ventricles but unaffected by IVF (P = 0.98). IVF promoted hematoma clearance, decreased mortality (22.4% vs. 40.9% with IVF vs. no IVF, respectively, P < 0.00001), improved good functional outcomes (47.2% [IVF] vs. 38.3% [no IVF], P = 0.03), and reduced the rate of catheter occlusion from 37.3% without IVF to 10.6% with IVF (P = 0.0003). CONCLUSIONS We present evidence and best practice recommendations for the treatment of IVH with EVD and intraventricular fibrinolysis. Our analysis further provides a comprehensive quantitative reference of the most relevant clinical endpoints for future studies on novel IVH technologies and treatments.
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Affiliation(s)
- Mette Haldrup
- Department of Neurosurgery, Aarhus University Hospital, Aarhus N, Denmark.
| | - Rares Miscov
- Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | - Niwar Mohamad
- Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Rasmussen
- Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Dyrskog
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | - Claus Ziegler Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Mads Grønhøj
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | | | | | - Birgit Debrabant
- Department of Mathematics and Computer Science, Data Science and Statistics, University of Southern Denmark, Odense M, Denmark
| | - Anders Rosendal Korshøj
- Department of Neurosurgery, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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4
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Chen Z, Yang C, Xin Y, Zou L, Wu B, Wang Y. Safety and Efficacy of Stereotaxic Surgery Combined with Urokinase in the Treatment of Ventricular Hemorrhage: A Retrospective Propensity-Matched Score Analysis. World Neurosurg 2023; 173:e586-e592. [PMID: 36858297 DOI: 10.1016/j.wneu.2023.02.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) is a severe and devastating stroke. Research on existing treatment options has been controversial. Therefore, we aimed to evaluate the safety and efficacy of minimally implanted stereotactic puncture combined with urokinase (uPA) in the treatment of IVH. METHODS The clinical data of 122 IVH patients admitted to our department from 2018 to 2022 were retrospectively analyzed. According to the modified RanKin score (mRS) after 30 days, the patients were divided into good prognosis (mRS 0-3) and poor prognosis (mRS 4-6), and the factors affecting the prognosis were screened by univariate and multivariate analysis, and then the tendency Score matching and paired patient screening were performed for comparative analysis between uPA and non-uPA groups. RESULTS Patients' age, uPA usage, initial Glasgow Coma Scale and primary blood volume all could affect the mRS score of patients. One hundred patients were finally included, including 50 cases in the uPA group and 50 cases in the non-uPA group. The analysis showed that at follow-up after 30 days, 46.0% of the patients in the uPA group and 28.0% in the non-uPA group had an mRS score of 0-3; however, they were not statistically significantly different. The postoperative hematoma clearance rate in the uPA group was significantly higher than that in the non-uPA group (P < 0.001), and the incidence of postoperative complications was not increased (P > 0.05). CONCIUSIONS uPA treatment can improve the treatment efficiency. However, its effect in improving patient outcomes does not appear to be significant.
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Affiliation(s)
- Ziwei Chen
- The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Chengbao Yang
- Liaoyang Central Hospital, Liaoyang City, Liaoning Province, China
| | - Yanhong Xin
- Jinzhou Central Hospital, Jinzhou City, Liaoning Province, China
| | - Liang Zou
- The First Affiliated Hospital of Harbin Medical University, Harbin City, Heilongjiang Province, China
| | - Botao Wu
- The First Affiliated Hospital of Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Yaodong Wang
- The Third Affiliated Hospital of Jinzhou Medical University, Jinzhou City, Liaoning Province, China.
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5
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Noiphithak R, Ratanavinitkul W, Yindeedej V, Nimmannitya P, Yodwisithsak P. Outcomes of Combined Endoscopic Surgery and Fibrinolytic Treatment Protocol for Intraventricular Hemorrhage: A Randomized Controlled Trial. World Neurosurg 2023; 172:e555-e564. [PMID: 36706982 DOI: 10.1016/j.wneu.2023.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Intraventricular fibrinolysis (IVF) and endoscopic surgery (ES) are the new promising treatment strategies to enhance the rate of hematoma clearance, which might improve functional outcome. This study investigated and compared the outcomes among these interventions. METHODS A randomized (1:1) double-blinded trial was carried out between August 2018 and December 2021. The intervention and control groups comprised patients receiving IVF and/or ES and external ventricular drainage (EVD), respectively. All participants had experienced primary or secondary intraventricular hemorrhage (IVH) from spontaneous intracerebral hemorrhage with obstructive hydrocephalus complications. The primary outcome was modified Rankin Scale score 180 days post treatment. Interim assessments were planned for every 50 participants enrolled to ensure safety and efficacy. RESULTS After enrollment of 110 participants (55 participants in each group), there was a difference in 30-day mortality (2 [3.6%] vs. 13 [32.7%] in the EVD group, P = 0.002), reaching the predetermined boundaries for termination of the trial. We demonstrated a better favorable outcome (modified Rankin Scale score 0-3) at 180 days in the intervention group, compared with the control group (35 [63.6%] vs. 24 [43.6%], P = 0.04). Participants in the intervention group experienced a higher IVH removal rate (91% [9.0] vs. 69.5% [38.0], P < 0.01) and had lower shunt conversion (1 [1.8%] vs. 16 [29.3%], P < 0.01). Treatment complications were comparable between the two groups. CONCLUSIONS This study demonstrated that combined ES and IVF is safe and effective for the treatment of IVH. In addition, it concluded that aggressive but safe procedures used to remove IVH could improve clinical outcome in patients with IVH.
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Affiliation(s)
- Raywat Noiphithak
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| | - Warot Ratanavinitkul
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Vich Yindeedej
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pree Nimmannitya
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pornchai Yodwisithsak
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Volkova AK, Polukarova EA, Ziborova SS, Borzikin SV, Kalinin AY. [Local fibrinolisis in nontraumatic intraventricular hemorrhages]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:136-141. [PMID: 37966453 DOI: 10.17116/jnevro2023123101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The management of patients with hemorrhagic stroke is an important problem in modern neurology and neurosurgery. The proportion of hemorrhagic stroke is only 15% of all cases of acute cerebrovascular accident, but mortality reaches 50% (and with intraventricular hemorrhages up to 80%), and disability is over 75%. Minimally invasive methods are being developed to reduce intraoperative damage to brain and improve the prognosis for the patient. One of them is ventricular external drainage (EVD) in combination with local fibrinolysis (LF). Intraventricular injection of thrombolytics allows the acceleration of the process of lysis and evacuation of blood. In this clinical observation, a 52-year-old female patient was admitted to the clinic with intracerebral hematoma and intraventricular hemorrhage, complicated by acute occlusive hydrocephalus. In the case of this patient, the use of external ventricular drainage in combination with local fibrinolysis made it possible to quickly resolve occlusive hydrocephalus, reduce the risk of death and increase the patient's rehabilitation potential.
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Affiliation(s)
- A K Volkova
- Novokuznetsk State Institute for Further Training of Physicians - Branch Campus of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia
| | - E A Polukarova
- Novokuznetsk State Institute for Further Training of Physicians - Branch Campus of Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia
| | - S S Ziborova
- Novokuznetsk City Clinical Hospital No. 1, Novokuznetsk, Russia
| | - S V Borzikin
- Novokuznetsk City Clinical Hospital No. 1, Novokuznetsk, Russia
| | - A Y Kalinin
- Novokuznetsk City Clinical Hospital No. 1, Novokuznetsk, Russia
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Kuramatsu JB, Gerner ST, Ziai W, Bardutzky J, Sembill JA, Sprügel MI, Mrochen A, Kölbl K, Ram M, Avadhani R, Falcone GJ, Selim MH, Lioutas VA, Endres M, Zweynert S, Vajkoczy P, Ringleb PA, Purrucker JC, Volkmann J, Neugebauer H, Erbguth F, Schellinger PD, Knappe UJ, Fink GR, Dohmen C, Minnerup J, Reichmann H, Schneider H, Röther J, Reimann G, Schwarz M, Bäzner H, Claßen J, Michalski D, Witte OW, Günther A, Hamann GF, Lücking H, Dörfler A, Ishfaq MF, Chang JJ, Testai FD, Woo D, Alexandrov AV, Staykov D, Goyal N, Tsivgoulis G, Sheth KN, Awad IA, Schwab S, Hanley DF, Huttner HB. Association of Intraventricular Fibrinolysis With Clinical Outcomes in Intracerebral Hemorrhage: An Individual Participant Data Meta-Analysis. Stroke 2022; 53:2876-2886. [PMID: 35521958 PMCID: PMC9398945 DOI: 10.1161/strokeaha.121.038455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with intracerebral hemorrhage (ICH), the presence of intraventricular hemorrhage constitutes a promising therapeutic target. Intraventricular fibrinolysis (IVF) reduces mortality, yet impact on functional disability remains unclear. Thus, we aimed to determine the influence of IVF on functional outcomes. METHODS This individual participant data meta-analysis pooled 1501 patients from 2 randomized trials and 7 observational studies enrolled during 2004 to 2015. We compared IVF versus standard of care (including placebo) in patients treated with external ventricular drainage due to acute hydrocephalus caused by ICH with intraventricular hemorrhage. The primary outcome was functional disability evaluated by the modified Rankin Scale (mRS; range: 0-6, lower scores indicating less disability) at 6 months, dichotomized into mRS score: 0 to 3 versus mRS: 4 to 6. Secondary outcomes included ordinal-shift analysis, all-cause mortality, and intracranial adverse events. Confounding and bias were adjusted by random effects and doubly robust models to calculate odds ratios and absolute treatment effects (ATE). RESULTS Comparing treatment of 596 with IVF to 905 with standard of care resulted in an ATE to achieve the primary outcome of 9.3% (95% CI, 4.4-14.1). IVF treatment showed a significant shift towards improved outcome across the entire range of mRS estimates, common odds ratio, 1.75 (95% CI, 1.39-2.17), reduced mortality, odds ratio, 0.47 (95% CI, 0.35-0.64), without increased adverse events, absolute difference, 1.0% (95% CI, -2.7 to 4.8). Exploratory analyses provided that early IVF treatment (≤48 hours) after symptom onset was associated with an ATE, 15.2% (95% CI, 8.6-21.8) to achieve the primary outcome. CONCLUSIONS As compared to standard of care, the administration of IVF in patients with acute hydrocephalus caused by intracerebral and intraventricular hemorrhage was significantly associated with improved functional outcome at 6 months. The treatment effect was linked to an early time window <48 hours, specifying a target population for future trials.
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Affiliation(s)
| | - Stefan T. Gerner
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Wendy Ziai
- Division of Brain Injury Outcomes, Johns Hopkins University, USA
| | | | | | | | - Anne Mrochen
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Kathrin Kölbl
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Malathi Ram
- Division of Brain Injury Outcomes, Johns Hopkins University, USA
| | - Radhika Avadhani
- Division of Brain Injury Outcomes, Johns Hopkins University, USA
| | - Guido J. Falcone
- Department of Neurology, Yale University School of Medicine, USA
- Department of Neurosurgery, Yale University School of Medicine, USA
| | - Magdy H. Selim
- Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | | | - Matthias Endres
- Department of Neurology, Charité–Universitätsmedizin Berlin, Germany
- Center for Stroke Research Berlin, Germany
- German Centre for Cardiovascular Research(DZHK), Germany
- German Center for Neurodegenerative Diseases(DZNE), Germany
| | - Sarah Zweynert
- Department of Neurology, Charité–Universitätsmedizin Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité–Universitätsmedizin Berlin, Germany
| | - Peter A. Ringleb
- Department of Neurology, Heidelberg University Hospital, Germany
| | - Jan C. Purrucker
- Department of Neurology, Heidelberg University Hospital, Germany
| | - Jens Volkmann
- Department of Neurology, University of Würzburg, Germany
| | - Hermann Neugebauer
- Department of Neurology, University of Würzburg, Germany
- Department of Neurology, University of Ulm, Germany
| | - Frank Erbguth
- Department of Neurology, Nuremberg General Hospital, Germany
| | - Peter D. Schellinger
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, Germany
| | - Ulrich J. Knappe
- Department of Neurosurgery, Johannes Wesling Medical Center Minden, Germany
| | | | - Christian Dohmen
- Department of Neurology, University of Cologne, Germany
- Department of Neurology, LVR-Hospital Bonn, Germany
| | - Jens Minnerup
- Department of Neurology, University of Münster, Germany
| | | | - Hauke Schneider
- Department of Neurology, University of Dresden, Germany
- Department of Neurology, Klinikum Augsburg, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinikum Hamburg Altona, Germany
| | | | | | | | - Joseph Claßen
- Department of Neurology, University of Leipzig, Germany
| | | | - Otto W. Witte
- Department of Neurology, University of Jena, Germany
| | | | - Gerhard F. Hamann
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Germany
| | - Hannes Lücking
- Department of Neuroradiology, University of Erlangen-Nuremberg, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Germany
| | | | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, USA
| | - Fernando D. Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, USA
| | | | - Dimitre Staykov
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, USA
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, USA
- Second Department of Neurology, Attikon University Hospital, School of Medicine, Greece
| | - Kevin N Sheth
- Department of Neurosurgery, Yale University School of Medicine, USA
| | - Issam A. Awad
- Department of Neurosurgery, University of Chicago, USA
| | - Stefan Schwab
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University, USA
| | - Hagen B. Huttner
- Department of Neurology, University of Erlangen-Nuremberg, Germany
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8
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Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2022; 53:e282-e361. [PMID: 35579034 DOI: 10.1161/str.0000000000000407] [Citation(s) in RCA: 395] [Impact Index Per Article: 197.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - William J Mack
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison
| | | | | | - Ilana M Ruff
- AHA Stroke Council Stroke Performance Measures Oversight Committee liaison
| | | | | | | | - Kevin N Sheth
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison.,AAN representative
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9
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Abstract
Intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) carry a very dismal prognosis. Several medical and surgical attempts have been made to reduce mortality and to improve neurological outcomes in survivors. Aggressive surgical treatment of ICH through craniotomy and microsurgical evacuation did not prove to be beneficial to these patients, compared to the best medical treatment. Similarly, the conventional treatment of IVH using an EVD is often effective in controlling ICP only initially, as it is very likely for the EVD to become obstructed by blood clots, requiring frequent replacements with a consequent increase of infection rates.Minimally invasive techniques have been proposed to manage these cases. Some are based on fibrinolytic agents that are infused in the hemorrhagic site through catheters with a single burr hole. Others are possible thanks to the development of neuroendoscopy. Endoscopic removal of ICH through a mini-craniotomy or a single burr hole, and via a parafascicular white matter trajectory, proved to reduce mortality in this population, and further randomized trials are expected to show whether also a better neurological outcome can be obtained in survivors. Moreover, endoscopy offers the opportunity to access the ventricular system to aspirate blood clots in patients with IVH. In such cases, the restoration of patency of the entire CSF pathway has the potential to improve outcome and reduce complications and now it is believed to decrease shunt-dependency.
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Affiliation(s)
- Alberto Feletti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Verona, Italy.
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10
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Su J, Xing Y, Liang S, Lin Q, Liu H. Transcortical approach surgery versus external ventricular drainage in treating intraventricular hemorrhage. Medicine (Baltimore) 2021; 100:e27443. [PMID: 34678873 PMCID: PMC8542114 DOI: 10.1097/md.0000000000027443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
Intraventricular hemorrhage is a serious intracerebral hemorrhagic disease with high mortality and poor prognosis. This retrospective study designed to investigate the therapeutic effect of transcortical approach surgery versus extraventricular drainage (EVD) on patients with intraventricular hemorrhage.Patients with intraventricular hemorrhage in Zhongshan City People's Hospital from January 01, 2014 to June 01, 2019 were retrospectively examined. They were divided into transcortical approach surgery groups and EVD groups to analyze the clinical characteristics and prognosis.A total of 96 patients were enrolled in the study (24 in the transcortical approach surgery group and 72 in the EVD group). The efficiency of postoperative operation was 15/19 in the transcortical approach surgery group and 24/48 in the EVD group (P = .012). The Glasgow Outcome Scale was 3.63 ± 1.27 in the transcortical approach surgery group and 2.80 ± 1.87 in the EVD group (P = .049). The postoperative residual blood volume was 9.62 ± 3.64 mL in the transcortical approach surgery group and 33.60 ± 3.53 mL in the EVD group (P < .001). The incidence of hydrocephalus after the operation was 1/23 in the transcortical approach surgery group and 19/53 in the EVD group. The 30-day postoperative mortality was 16/56 in the EVD group and 1/23 in the transcortical approach surgery group. The transcortical approach surgery group was significantly better compared with the EVD group.This study showed that the transcortical approach for ventricular hemorrhage compared with EVD improved the hematoma clearance rate, shortened catheterization time, reduced the incidence of postoperative hydrocephalus, decreased patient mortality, led to a better prognosis, and reduced complications of hydrocephalus.
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Affiliation(s)
- Jiahao Su
- Neurosurgery Department, Zhongshan City People's Hospital, Zhongshan, China
| | - Yichun Xing
- Department of Gynecology, Sun Yat-sen Memorial Hospital Affiliated of Sun Yat-sen University, Guangzhou, China
| | - Sitao Liang
- Neurosurgery Department, Zhongshan City People's Hospital, Zhongshan, China
| | - Qichang Lin
- Neurosurgery Department, Zhongshan City People's Hospital, Zhongshan, China
| | - Huijiao Liu
- Department of Critical Care Medicine, Zhongshan City People's Hospital, Zhongshan, China
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11
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Abstract
Hemorrhagic stroke comprises about 20% of all strokes, with intracerebral hemorrhage (ICH) being the most common type. Frequency of ICH is increased where hypertension is untreated. ICH in particularly has a disproportionately high risk of early mortality and long-term disability. Until recently, there has been a paucity of randomized controlled trials (RCTs) to provide evidence for the efficacy of various commonly considered interventions in ICH, including acute blood pressure management, coagulopathy reversal, and surgical hematoma evacuation. Evidence-based guidelines do exist for ICH and these form the basis for a framework of care. Current approaches emphasize control of extremely high blood pressure in the acute phase, rapid reversal of vitamin K antagonists, and surgical evacuation of cerebellar hemorrhage. Lingering questions, many of which are the topic of ongoing clinical research, include optimizing individual blood pressure targets, reversal strategies for newer anticoagulant medications, and the role of minimally invasive surgery. Risk stratification models exist, which derive from findings on clinical exam and neuroimaging, but care should be taken to avoid a self-fulfilling prophecy of poor outcome from limiting treatment due to a presumed poor prognosis. Cerebral venous thrombosis is an additional subtype of hemorrhagic stroke that has a unique set of causes, natural history, and treatment and is discussed as well.
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Affiliation(s)
- Arturo Montaño
- Departments of Neurology and Neurosurgery, University of Colorado, Aurora, CO, United States
| | - Daniel F Hanley
- Departments of Neurology and Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - J Claude Hemphill
- Departments of Neurology and Neurosurgery, University of California San Francisco, San Francisco, CA, United States.
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12
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van Solinge TS, Muskens IS, Kavouridis VK, Gormley WB, Mekary RA, Broekman MLD, Arnaout O. Fibrinolytics and Intraventricular Hemorrhage: A Systematic Review and Meta-analysis. Neurocrit Care 2020; 32:262-271. [PMID: 31376141 PMCID: PMC7012971 DOI: 10.1007/s12028-019-00786-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intraventricular hemorrhage (IVH) is an independent poor prognostic factor in subarachnoid and intra-parenchymal hemorrhage. The use of intraventricular fibrinolytics (IVF) has long been debated, and its exact effects on outcomes are unknown. A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines to assess the impact of IVF after non-traumatic IVH on mortality, functional outcome, intracranial bleeding, ventriculitis, time until clearance of third and fourth ventricles, obstruction of external ventricular drains (EVD), and shunt dependency. Nineteen studies were included in the meta-analysis, totaling 1020 patients. IVF was associated with lower mortality (relative risk [RR] 0.58; 95% confidence interval [CI] 0.47-0.72), fewer EVD obstructions (RR 0.41; 95% CI 0.22-0.74), and a shorter time until clearance of the ventricles (median difference [MD] - 4.05 days; 95% CI - 5.52 to - 2.57). There was no difference in good functional outcome, RR 1.41 (95% CI 0.98-2.03), or shunt dependency, RR 0.93 (95% CI 0.70-1.22). Correction for publication bias predicted an increased risk of intracranial bleeding, RR 1.67 (95% CI 1.01-2.74) and a lower risk of ventriculitis, RR 0.68 (95% CI 0.45-1.03) in IVH patients treated with IVF. IVF was associated with improved survival, faster clearance of blood from the ventricles and fewer drain obstructions, but further research is warranted to elucidate the effects on ventriculitis, long-term functional outcomes, and re-hemorrhage.
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Affiliation(s)
- Thomas S van Solinge
- Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Ivo S Muskens
- Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vasileios K Kavouridis
- Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William B Gormley
- Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston, MA, USA
| | - Marike L D Broekman
- Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Omar Arnaout
- Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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Luong CQ, Nguyen AD, Nguyen CV, Mai TD, Nguyen TA, Do SN, Dao PV, Pham HTM, Pham DT, Ngo HM, Nguyen QH, Nguyen DT, Tran TH, Le KV, Do NT, Ngo ND, Nguyen VD, Ngo HD, Hoang HB, Vu HV, Vu LT, Ngo BT, Nguyen BX, Khuong DQ, Nguyen DT, Vuong TX, Be TH, Gaberel T, Nguyen LV. Effectiveness of Combined External Ventricular Drainage with Intraventricular Fibrinolysis for the Treatment of Intraventricular Haemorrhage with Acute Obstructive Hydrocephalus. Cerebrovasc Dis Extra 2019; 9:77-89. [PMID: 31408859 PMCID: PMC6751468 DOI: 10.1159/000501530] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Intraventricular haemorrhage (IVH) patients with acute obstructive hydrocephalus (AOH) who require external ventricular drainage (EVD) are at high risk for poor outcomes. Intraventricular fibrinolysis (IVF) with low-dose recombinant tissue plasminogen activator (rtPA) can be used to improve patient outcomes. Here, we evaluated the impact of IVF on the risk of death and the functional outcomes in IVH patients with AOH. METHODS This prospective cohort study included IVH patients with hypertensive intracranial haemorrhage complicated by AOH who required EVD. We evaluated the risk of death and the functional outcomes at 1 and 3 months, with a specific focus on the impact of combined EVD with IVF by low-dose rtPA. RESULTS Between November 30, 2011 and December 30, 2014, 80 patients were included. Forty-five patients were treated with EVD alone (EVD group) and 35 received IVF (EVD+IVF group). The 30- and 90-day mortality rates were lower in the EVD+IVF group than in the EVD group (42.2 vs. 11.4%, p = 0.003, and 62.2 vs. 20%, p < 0.001, respectively). The Graeb scores were significantly lower in the EVD+IVF group than in the EVD group (p ≤ 0.001) during the first 3 days and on day 7 after assignment. The 30-day good functional outcome (modified Rankin Scale [mRS] score 0-3) was also higher in the EVD+IVF group than in the EVD group (6.7 vs. 28.6%, p = 0.008). However, the 90-day good functional outcome (mRS score 0-3) did not significantly increase in the EVD+IVF group (30.8% in the EVD group vs. 51.6% in the EVD+IVF group, p = 0.112). CONCLUSIONS In our prospective observational study, EVD+IVF was associated with a lower risk of death in IVH patients. EVD+IVF improved the chance of having a good functional outcome at 1 month; however, this result was no longer observed at 3 months.
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Affiliation(s)
- Chinh Quoc Luong
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam, .,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam,
| | - Anh Dat Nguyen
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Chi Van Nguyen
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Ton Duy Mai
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Son Ngoc Do
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | | | - Hanh Thi My Pham
- Epidemiology Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Dung Thi Pham
- Department of Science Management, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hung Manh Ngo
- Department of Neurosurgery II, Viet Duc Hospital, Hanoi, Vietnam
| | - Quan Huu Nguyen
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | | | - Thong Huu Tran
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Ky Van Le
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Nam Trong Do
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Ngoc Duc Ngo
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | | | - Hung Duc Ngo
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Bui Hoang
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Ha Viet Vu
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Lan Tuong Vu
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Binh Thanh Ngo
- Undergraduate Training and Management Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Bai Xuan Nguyen
- Department of Postgraduate Management, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | | | | | | | - Thu Hong Be
- Poison Control Centre, Bach Mai Hospital, Hanoi, Vietnam
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Caen, France.,Department of Neurosurgery, University of Caen Normandy, Caen, France
| | - Lieu Van Nguyen
- Department of Neurology, Bach Mai Hospital, Hanoi, Vietnam.,Department of Neurology, Hanoi Medical University, Hanoi, Vietnam
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14
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Abstract
PURPOSE OF REVIEW This article describes the advances in the management of spontaneous intracerebral hemorrhage in adults. RECENT FINDINGS Therapeutic intervention in intracerebral hemorrhage has continued to focus on arresting hemorrhage expansion, with large randomized controlled trials addressing the effectiveness of rapidly lowering blood pressure, hemostatic therapy with platelet transfusion, and other clotting complexes and clot volume reduction both of intraventricular and parenchymal hematomas using minimally invasive techniques. Smaller studies targeting perihematomal edema and inflammation may also show promise. SUMMARY The management of spontaneous intracerebral hemorrhage, long relegated to the management and prevention of complications, is undergoing a recent evolution in large part owing to stereotactically guided clot evacuation techniques that have been shown to be safe and that may potentially improve outcomes.
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15
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Yu Z, Guo R, Zheng J, Li M, Wen D, Li H, You C, Ma L. Comparison of Acute Moyamoya Disease-Related and Idiopathic Primary Intraventricular Hemorrhage in Adult Patients. World Neurosurg 2019; 125:e313-e318. [PMID: 30685378 DOI: 10.1016/j.wneu.2019.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Primary intraventricular hemorrhage (PIVH) is a rare condition in adult patients. PIVH occurs frequently in adult hemorrhagic Moyamoya disease (MMD). Idiopathic PIVH is defined as PIVH without cerebrovascular abnormalities. This study is aimed to compare the baseline characteristics and outcomes of acute MMD-related and idiopathic PIVH. METHODS Adult patients with acute MMD-related or idiopathic PIVH were retrospectively included. Baseline characteristics and outcomes at discharge were obtained and compared. Chi-square test, Student's t-test, or rank-sum test were used in statistical analyses. RESULTS This study finally included 32 patients with acute MMD-related PIVH and 112 with acute idiopathic PIVH. Patients with acute MMD-related PIVH were significantly younger (53.3 ± 15.8 vs. 42.8 ± 12.2 years, P < 0.001). The admission systolic blood pressure in patients with acute idiopathic PIVH was significantly higher (161.7 ± 30.9 vs. 134.6 ± 24.6 mm Hg, P < 0.001). Patients with acute idiopathic PIVH had significantly higher admission serum urea (5.68 ± 2.66 vs. 4.34 ± 1.62 mmol/L, P = 0.008), cystatin C (0.97 ± 0.72 vs. 0.68 ± 0.16 mg/L, P = 0.023), and uric acid (309.01 ± 105.97 vs. 242.24 ± 77.65 μmol/L, P = 0.001). In patients with acute MMD-related PIVH, only one (3.1%) patient was dead at discharge. In contrast, a total of 22 (19.6%) patients with acute idiopathic patients died at discharge (P = 0.027). CONCLUSIONS Compared with patients with acute idiopathic PIVH, patients with acute MMD-related PIVH have younger age, lower blood pressure, and better renal function. Moreover, patients with acute MMD-related PIVH have lower short-term mortality.
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Affiliation(s)
- Zhiyuan Yu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui Guo
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mou Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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16
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Cordonnier C, Demchuk A, Ziai W, Anderson CS. Intracerebral haemorrhage: current approaches to acute management. Lancet 2018; 392:1257-1268. [PMID: 30319113 DOI: 10.1016/s0140-6736(18)31878-6] [Citation(s) in RCA: 385] [Impact Index Per Article: 64.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 12/14/2022]
Abstract
Acute spontaneous intracerebral haemorrhage is a life-threatening illness of global importance, with a poor prognosis and few proven treatments. As a heterogeneous disease, certain clinical and imaging features help identify the cause, prognosis, and how to manage the disease. Survival and recovery from intracerebral haemorrhage are related to the site, mass effect, and intracranial pressure from the underlying haematoma, and by subsequent cerebral oedema from perihaematomal neurotoxicity or inflammation and complications from prolonged neurological dysfunction. A moderate level of evidence supports there being beneficial effects of active management goals with avoidance of early palliative care orders, well-coordinated specialist stroke unit care, targeted neurointensive and surgical interventions, early control of elevated blood pressure, and rapid reversal of abnormal coagulation.
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Affiliation(s)
- Charlotte Cordonnier
- University of Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, Centre Hospitalier Universitaire Lille, Department of Neurology, Lille, France
| | - Andrew Demchuk
- Department of Clinical Neurosciences, University of Calgary, AB, Canada
| | - Wendy Ziai
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The George Institute China at Peking University Health Science Center, Beijing, China.
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17
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Joslyn LR, Pienaar E, DiFazio RM, Suliman S, Kagina BM, Flynn JL, Scriba TJ, Linderman JJ, Kirschner DE. Integrating Non-human Primate, Human, and Mathematical Studies to Determine the Influence of BCG Timing on H56 Vaccine Outcomes. Front Microbiol 2018; 9:1898. [PMID: 30177934 PMCID: PMC6110197 DOI: 10.3389/fimmu.2018.01898] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022] Open
Abstract
Background Acute lung injury (ALI) is characterized by suppressed fibrinolytic activity in bronchoalveolar lavage fluid (BALF) attributed to elevated plasminogen activator inhibitor-1 (PAI-1). Restoring pulmonary fibrinolysis by delivering tissue-type plasminogen activator (tPA), urokinase plasminogen activator (uPA), and plasmin could be a promising approach. Objectives To systematically analyze the overall benefit of fibrinolytic therapy for ALI reported in preclinical studies. Methods We searched PubMed, Embase, Web of Science, and CNKI Chinese databases, and analyzed data retrieved from 22 studies for the beneficial effects of fibrinolytics on animal models of ALI. Results Both large and small animals were used with five routes for delivering tPA, uPA, and plasmin. Fibrinolytics significantly increased the fibrinolytic activity both in the plasma and BALF. Fibrin degradation products in BALF had a net increase of 408.41 ng/ml vs controls (P < 0.00001). In addition, plasma thrombin–antithrombin complexes increased 1.59 ng/ml over controls (P = 0.0001). In sharp contrast, PAI-1 level in BALF decreased 21.44 ng/ml compared with controls (P < 0.00001). Arterial oxygen tension was improved by a net increase of 15.16 mmHg, while carbon dioxide pressure was significantly reduced (11.66 mmHg, P = 0.0001 vs controls). Additionally, fibrinolytics improved lung function and alleviated inflammation response: the lung wet/dry ratio was decreased 1.49 (P < 0.0001 vs controls), lung injury score was reduced 1.83 (P < 0.00001 vs controls), and BALF neutrophils were lesser (3 × 104/ml, P < 0.00001 vs controls). The mortality decreased significantly within defined study periods (6 h to 30 days for mortality), as the risk ratio of death was 0.2-fold of controls (P = 0.0008). Conclusion We conclude that fibrinolytic therapy may be effective pharmaceutic strategy for ALI in animal models.
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Affiliation(s)
- Louis R Joslyn
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Elsje Pienaar
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Robert M DiFazio
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Sara Suliman
- South African Tuberculosis Vaccine Initiative and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Benjamin M Kagina
- South African Tuberculosis Vaccine Initiative and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative and Institute of Infectious Disease and Molecular Medicine, Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Jennifer J Linderman
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Denise E Kirschner
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
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18
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Koschnitzky JE, Keep RF, Limbrick DD, McAllister JP, Morris JA, Strahle J, Yung YC. Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop. Fluids Barriers CNS 2018; 15:11. [PMID: 29587767 PMCID: PMC5870202 DOI: 10.1186/s12987-018-0096-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
The Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop was held on July 25 and 26, 2016 at the National Institutes of Health. The workshop brought together a diverse group of researchers including pediatric neurosurgeons, neurologists, and neuropsychologists with scientists in the fields of brain injury and development, cerebrospinal and interstitial fluid dynamics, and the blood-brain and blood-CSF barriers. The goals of the workshop were to identify areas of opportunity in posthemorrhagic hydrocephalus research and encourage scientific collaboration across a diverse set of fields. This report details the major themes discussed during the workshop and research opportunities identified for posthemorrhagic hydrocephalus. The primary areas include (1) preventing intraventricular hemorrhage, (2) stopping primary and secondary brain damage, (3) preventing hydrocephalus, (4) repairing brain damage, and (5) improving neurodevelopment outcomes in posthemorrhagic hydrocephalus.
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Affiliation(s)
| | - Richard F. Keep
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - David D. Limbrick
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - James P. McAllister
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Jill A. Morris
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Neuroscience Center, 6001 Executive Blvd, NSC Rm 2112, Bethesda, MD 20892 USA
| | - Jennifer Strahle
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Yun C. Yung
- Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Rd., Building 7, La Jolla, CA 92037 USA
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